Characterization of the Effect of an ECM Based Adhesion Barrier on Healing of Bowel Anastomoses

项目摘要 美国每年进行超过700万例腹部和盆腔手术， 这些手术后近90%的患者的术后发病原因。粘连是 疤痕组织的带导致无数终身并发症的表现（例如，慢性盆腔 疼痛，小肠梗阻和不孕症），每年的医疗保健负担超过25亿美元，但目前 减轻粘附形成的选择是有限的和有缺陷的。基于近十年的研究，我们 开发了一种源自细胞外基质的可喷雾的粘连屏障（ECM喷雾），其用作 机械屏障，从患者自身身体激发愈合反应，以防止粘连并调节 组织修复ECM喷雾剂具有热响应性，并在组织上形成薄膜水凝胶， 应用并通过作为相邻组织之间的机械屏障来防止粘连。在两个单独 使用经验证的小型和大型动物模型进行的临床前研究，术后应用ECM喷雾剂， 导致粘连发生率和韧性降低>75%。目前可用的粘合剂的一个主要限制是 障碍是它们禁忌用于涉及肠切除和重新连接的手术 (i.e.,肠吻合术），因为已经显示粘连屏障抑制愈合， 泄漏有趣的是，我们已经证明，当应用于手术损伤的腹膜，ECM喷雾作为一个 支架以支持腹膜的上皮再形成和愈合。然而，目前还不清楚ECM Spray 将与肠吻合术中发生的更复杂的伤口愈合过程相互作用。 因此，本研究的目的是确定ECM喷雾剂用于预防 同时在吻合术后安全地维持肠愈合。在目标1中，我们将确定 ECM喷雾剂对粘连预防的功效和表征ECM喷雾剂对肠愈合的作用。 在目标2中，我们将确定ECM喷雾剂是否可以促进高风险模型中的吻合口愈合。 肠道修复拟议工作的结果将导致一个关键的研究和发展的里程碑必要的 确定ECM喷雾剂用于腹部和盆腔手术的安全性和有效性，并增加 ECM喷涂的技术和商业潜力。此外，如果我们显示ECM喷涂的潜力， 吻合口漏，这将扩大使用范围并显著增加患者和临床影响， 以及鼓励外科医生在结肠直肠手术中采用。

Project Summary Over 7 million abdominal and pelvic operations are performed each year in the US and adhesions—the leading cause of post-operative morbidity—form in nearly 90% of patients following these surgeries. Adhesions are bands of scar tissue that contribute to the manifestation of myriad life-long complications (e.g., chronic pelvic pain, small bowel obstruction, and infertility) and the annual healthcare burden exceeds $2.5 billion, but current options to mitigate adhesion formation are limited and flawed. Based on nearly a decade of research, we have developed a sprayable adhesion barrier derived from extracellular matrix (ECM Spray), which serves as a mechanical barrier that elicits a healing response from the patient’s own body to prevent adhesions and regulate tissue repair. The ECM Spray is thermally responsive and forms a thin film hydrogel over the tissue where it’s applied and prevents adhesions by acting as a mechanical barrier between adjacent tissues. In two separate pre-clinical studies using validated small and large animal models, post-operative application of ECM Spray has resulted in >75% reduction in adhesion incidence and tenacity. A major limitation of currently available adhesion barriers is that they are contraindicated for use in procedures that involve a bowel resection and re-connection (i.e., bowel anastomosis) because the adhesion barriers have been shown to inhibit healing which can cause leakage. Interestingly, we’ve shown that when applied to surgically injured peritoneum, ECM Spray acts as a scaffold to support re-epithelialization and healing of the peritoneum. However, it is unknown how ECM Spray will interact with more complex wound healing processes which occur in intestinal anastomosis procedures. Therefore, the objective of the present study is to determine the efficacy of ECM Spray’s for preventing adhesions while safely maintaining bowel healing following anastomosis procedures. In Aim 1, we will determine the efficacy of ECM Spray on adhesion prevention and characterize the effect of ECM Spray on intestinal healing. In Aim 2, we will determine whether ECM Spray may promote anastomotic healing in a high-risk model of intestinal repair. Results of the proposed work will lead to a key research and development milestone necessary for establishing safety and efficacy of ECM Spray for use in abdominal and pelvic operations and increase the technological and commercial potential of ECM Spray. In addition, if we show potential for ECM Spray to limit anastomotic leaks, this will broaden the scope for use and dramatically increase the patient and clinical impact, as well as encourage surgeon adoption in colorectal surgeries.